Bill C-7 (Historical)

An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Alleged Premature Disclosure of Private Member's Bill

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Madam Speaker, in light of an apology from the member for Markham—Unionville with respect to the premature disclosure of his bill, I too, would like to apologize unreservedly for the premature disclosure of the contents of Bill C-7, medical assistance in dying.

I would like to state categorically that no one from the government was authorized to speak publicly on this bill prior to its introduction.

Palliative Care

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, there is one thing I have learned since being elected, and that is that what the left says never means what people might think it means.

When Liberals talk about unity, what they really mean is “My way or the highway.” When they talk about diversity, they never mean diversity of opinion. When they talk about truth and reconciliation, they have no intention of respecting elected band councils unless it is convenient. When they talk about consultation, what they really mean is, “Let me tell you what I think.” When they say “dying with dignity”, they only mean euthanasia.

Canadians look to this House for compassion, truth and leadership. In light of this week's debate on Bill C-7, let us ensure that when we say we are committed to quality palliative care, we truly mean what we say we mean.

Opposition Motion—Additional Allotted Days

[John Nater, Conservative, Perth—Wellington, ON]

Madam Speaker, “Parliament is more than procedure – it is the custodian of the nation’s freedom.” Those words were spoken by the great defender of parliamentary democracy, the Right Hon. John George Diefenbaker.

Today, we find ourselves called upon to once again stand in support of this great institution, to once again stand for the right of opposition parliamentarians to hold the government to account.

Many Canadians may not be closely following the business of supply. They may not closely follow the allotted days, or the opposition days, that are often called in Parliament. However, these days, in which the agenda of the House falls to the opposition parties, are absolutely essential to our great parliamentary democracy. We as the opposition, both the official opposition and the other opposition parties, have the right to bring forward matters that we feel are important to our constituents and to all Canadians.

Beauchesne's Parliamentary Rules and Forms, sixth edition, states “The Opposition prerogative is very broad in the use of the allotted day and ought not to be interfered with except on the clearest and most certain procedural grounds.”

We have brought forward this opposition day motion on this day for very important reasons. The Liberal government decided to punish the official opposition by giving us a short parliamentary day, a short day when only two full speaking slots would be allocated to the opposition parties.

The Liberal government seems to have forgotten that it is among the weakest governing mandate in Canadian history. The Liberals forget that they actually lost the popular vote in the last election and Canadians saw fit to return them with a minority of seats in this place.

Bosc and Gagnon states the following, on page 855:

The setting aside of a specified number of sitting days on which the opposition chooses the subject of debate derives from the tradition which holds that Parliament does not grant supply until the opposition has had an opportunity to demonstrate why it should be refused.

In other words, before we as the opposition can consent to the continued funding of the government, we must, and we will, have the opportunity to raise our concerns in this place. We will not be silenced. We will not accept that the government, and only the government, has a legitimate voice in this place.

I would remind members of the Liberal Party that they are first and foremost members of the legislative branch of government. Those who do not sit in cabinet are not members of the executive branch. They are parliamentarians and parliamentarians first and foremost. They too should be concerned that the members of the executive branch of government are the ones who are trying to control the debate of this very place.

I ought not to need to remind the government of its legislative record and its mismanagement of House time in the previous Parliament. At the time of dissolution, it had left at least 17 government bills lying on the Order Paper. This is in spite of the fact that it used time allocation on dozens of occasions. On top of that, there were 13 motions for closure and 40 motions to proceed to orders of the day, thereby bypassing the opportunity for opposition MPs to move concurrence motions or to table petitions on behalf of the constituents in each of our 338 ridings across the country.

Today's debate is about returning the House to the people, to give the official opposition, the Bloc Québécois and the New Democratic Party each one additional opposition day during the supply period, to give each of these parties the opportunity to raise the issues before granting supply to the Liberal government.

I do not need to remind the House either about the disregard we have seen in the past by the Liberal Party to this institution.

In the previous Parliament, on one of its very first bills, Bill C-14, the medical assistance in dying act, the Liberal government was found to have contravened the rights and privileges of the House by leaking the contents to the media before it was tabled for all parliamentarians to see. Old habits die hard, because it appears it did that once again this time with Bill C-7, the amendments to medical assistance in dying.

The Conservatives do not need to remind the Liberals either about the impacts they bring upon themselves when they attempt to use draconian measures to shut down debate in the House. We all remember Motion No. 6, when they tried to unilaterally take control of every mechanism for debate in the House. We do not need to remind the Liberals of the standing order standoff, when they tried to diminish the opportunity for the opposition to hold the government to account by unilaterally changing the rules of the House. It fell to the Conservatives, as the official opposition, and the third party, the New Democrats, to ensure we were that line of defence, that we were that thin line of the wedge to prevent the Liberal government from doing that.

In fact, in the previous Parliament, during a debate in this very House on a question of privilege, one of the most significant matters with which the House can be seized, a Liberal member of Parliament, the member for Brossard—Saint-Lambert, stood in the House, used a procedural measure to move to orders of the day and killed that debate. However, our Parliament is stronger than any one Liberal member of Parliament. At that time, the Speaker saw fit to return that question of privilege to the House so members of Parliament could have their voices heard.

We see this time and again with the Liberal government. At every opportunity it has to do the right thing, it goes the opposite direction.

That brings me to the events we have seen just in the last couple of weeks on the new NAFTA. It is not a great deal and it is not the worst deal; it is somewhere in between. We are the party of free trade and we support the implementation of the new NAFTA despite its imperfections. However, to hear the Deputy Prime Minister state publicly and in this place that the Conservative Party was somehow trying to delay the new NAFTA is an insult to the opposition and to the House of Commons.

Just yesterday, my colleague, the opposition House leader, gave the Liberals the opportunity to right their wrong by bringing forward NAFTA today. We could be debating NAFTA today and I could be raising the concerns of the people of Perth—Wellington, the farmers, the manufacturers, individuals who have concerns with the bill. However, the Liberals did not budge. In fact, speaking for the government, the parliamentary secretary to the government House leader said no, that the government would not be willing to bring NAFTA forward. That is unacceptable.

We stand here today debating this opposition motion, a motion that gives the rights and responsibilities of the House back to all its members. I encourage all members to stand for their parliamentary privilege, to stand for democracy and vote in favour of this motion.

Criminal Code

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Madam Speaker, all of the speeches in the House come from a great place. On my side of the House we value life, and that is meritorious. We have heard other perspectives that talk about ending suffering and that truly has merit, so I appreciate all of the speeches that have taken place on such an important topic.

I know members have gone over this, but just for clarity I want to go over the background for medically assisted suicide in Canada. The 2015 Carter case was a landmark decision for the Supreme Court of Canada. The previous prohibition for assisted suicide was challenged as contrary to the Charter of Rights and Freedoms. In a unanimous decision, the court abolished the provision in the Criminal Code, thereby giving mentally competent Canadians who were suffering intolerably the right to medical assistance in dying when they had provided clear consent.

In June 2016, the first legislation on medical assistance in dying was passed in Canada's Parliament. In the recent 2019 Truchon decision, the Superior Court of Québec considered the constitutionality and Quebec's requirements in accessing MAID. The plaintiffs in the Truchon case were suffering from grave and incurable medical conditions that were causing tremendous suffering and a total loss of autonomy. However, they had each been refused MAID under the legislation in Quebec and federally. Because they were not at the end of life for the Quebec legislation and federally, death was not reasonably foreseeable.

Madam Justice Baudouin held that “reasonably foreseeable natural death” in the federal provisions infringed the plaintiff's fundamental rights under sections 7 and 15 of the charter. The court declared the impugned provisions unconstitutional. In a surprising and, in my mind, incorrect decision, the government chose not to challenge this decision, thereby getting guidance from higher courts such as the Supreme Court. By not challenging this legislation, the Liberal government was admitting that the legislation the House passed was deeply flawed.

The court's decision in Truchon gave the government until March 2020, which is now in the process of being extended, to amend the legislation to remove the reasonable foreseeability of death criteria from the MAID legislation. Prior to the introduction of this bill, the government conducted a narrow consultation process, limiting its consultations to urban centres and online surveys.

The minister noted several times, in his address to the House, that the provisions of Bill C-7 were the result of this process. However, he will not share that consultation with Parliament. This lack of respect is disheartening, and counterproductive to open and meaningful dialogue. I wish the government would stop playing games with such important topics and share the information it has with this minority Parliament.

Given that there is a limited timeline, that we are in a minority Parliament, and that MAID legislation will be subject to a complete review this summer, I would have expected the government to take a limited approach. Rather, the government has chosen to take a very different approach. The legislation makes substantial changes to the MAID eligibility far and beyond what is required to the Truchon decision.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, medical assistance in dying, or MAID, is complex. It is a deeply personal and difficult topic, yet this past January alone, more than 300,000 Canadians took part in the online public consultation to have their say. Many others, including experts and family members of loved ones who received MAID, took part in round-table discussions.

We also heard how the legislation is working from many of the conscientious health care providers involved in delivering this service. Canadians are engaged and aware of the importance of bringing the compassionate, sensible measures contained within Bill C-7, an act to amend the Criminal Code (medical assistance in dying).

This bill builds on the foundation laid by the current legislation on MAID, passed by Parliament in June 2016, and extends eligibility for MAID to persons who, while suffering intolerably, may not be at the end of life. This bill respects the Truchon decision and supports the autonomy of Canadians wanting to make an informed choice to end the suffering they face as a result of serious illness, regardless of whether their condition is life-threatening in the near term.

Respecting the autonomy of Canadians while protecting the safety of vulnerable people remains our central objective. That is why Bill C-7 proposes a two-track approach to safeguards, based on whether or not a person's death is reasonably foreseeable.

We have proposed to ease certain safeguards that had the unintended consequence of creating a barrier for someone accessing MAID whose death is deemed reasonably foreseeable, and we will introduce new and modified safeguards for eligible persons whose death is not reasonably foreseeable.

Bill C-7 would permit the waiving of final consent for persons at the end of life who have been already assessed and approved to receive MAID, but who are at risk of losing their decision-making capacity before it can be provided. There was very strong support for this type of amendment from Canadians, experts, health care providers and their professional regulating bodies.

Our government recognizes the importance of data and science-based evidence in the decision-making process. That is why this bill proposes that we expand data collection through the federal monitoring regime to provide a more complete picture of MAID in Canada.

I would like to note that following the Truchon decision there has been widespread speculation about the potential for persons solely with mental illness to be eligible for MAID. However, many stakeholders in the mental health community have expressed deep concern about this possibility. They feel this option directly conflicts with important treatment principles, which are that there is always hope for recovery and that people can live fulfilling lives with a mental illness.

From the perspective of many health care providers and many health care specialists, assessing eligibility for such individuals poses numerous challenges. Mental illnesses are not generally considered to be incurable, which is a requirement under the current law. In addition, the trajectory of such conditions can be more difficult to predict.

In light of the multiple challenges we heard and the lack of support from the practitioner community who would bear the responsibility for conducting eligibility assessments, this bill does not permit MAID for persons whose sole medical condition is a mental illness.

This decision was not taken lightly. It in no way implies that suffering associated with mental illness is any less severe or more tolerable than that associated with another medical condition, such as one arising from a physical condition. Rather, this decision reflects the many uncertainties underlying this question and a concern that allowing MAID in these circumstances could place Canadians at risk.

We recognize that there are proponents who support MAID eligibility for persons solely with a mental illness. However, in light of the Quebec court decision and the compressed time frame for legislative amendments, there is insufficient time to fully address this topic and determine whether a regime that allows access to MAID for persons whose sole underlying condition is a mental illness is viable.

For these reasons, we are adopting an incremental and cautious approach. It is our view that this issue should be explored as part of the parliamentary review process, which is expected to begin later this year.

It is easy as parliamentarians and as legislators to lose the human element of what we do and to focus on talking points and politics, but these compassionate and sensible measures have come from extensive consultation with Canadians, experts and folks who have lived with the unintended consequences of the original legislation.

These are folks like the late Audrey Parker, a Nova Scotian who wanted to spend just one last Christmas with her family but ended her life through MAID two months prior, while she could still give consent.

I want to take this time to read some of Audrey Parker's final posts into the record so they will be preserved in Hansard, because this legislation includes her amendment. As my colleagues in the House debate, discuss and study the bill, I want them to remember that there are many folks like Audrey across Canada who deserve this autonomy and this compassion.

She said:

“This is my last note to you. I can tell you I loved my life so much and I have no regrets. I feel like I’m leaving as my best self and I’m ready to see what happens when I die today. I’m hoping for something exciting to happen but I guess I won’t know until the time is here.

“The one thing I’m happiest about, is that I finally found ‘my people’ during my lifetime. I’ve even met new people that I already adore near the end of my journey so it’s never too late for anything in life.

“In the spirit of teaching and sharing, I’d like to leave you with some words that explain my position with MAID.

“When the MP’s debated MAID federally, someone decided to add late stage consent as a fail-safe to ensure no one dies at the hand of another.

“There are four categories of MAID candidates.... Of the four categories, the only one that is cut and dried is my category of Assessed and Approved. We are terminal, suffering outrageous pain and there is no time frame with using MAID. The kicker that makes it difficult is the late stage consent.

“As I near my death today, it is even more evident than ever before, that late stage consent has got to be amended and removed from MAID in Canada for my category of end users.”

“Dying is a messy business. I can’t predict when cancer will move into my brain matter or when something else big happens to make me more unwell. I and only I can make that decision for myself. It’s about living out every extra day that I can. No one including my doctor knows what the right day to die will be. Only I can know that as I wake each day. I’m not going to wait until I lose myself.... I wanted to make it to Christmas and New Year’s Eve... my favorite time of the year but I lost that opportunity because of a poorly thought out federal law.

“Had late stage consent been abolished, I simply would have taken my life one day at a time. If I noticed I was losing capacity, I would have taken control myself....and called my doctor to come assist me with my death. All I have to give is 24 hours notice so she can pick up the drugs from the drug store in my neighborhood. We were totally organized but the law tied our hands.

“This decision has to come from the patient. No one else. That’s why we the dying should be living day to day until we have to leave by invoking MAID.

“Be happy everyone and be kind to others.... Audrey.”

I ask that all members in the House support Bill C-7.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her speech.

I would like to remind her that medical assistance in dying is an intervention allowed only in exceptional cases, under very strict conditions. Access to this intervention is strictly regulated by law.

Bill C-7 will not bring about an unreasonable increase in MAID cases. According to a report of Quebec's commission on end-of-life care, from December 10, 2015, to March 31, 2018, a total of 830 requests for MAID were denied for various reasons, including the death of the person before the procedure, the withdrawal of the request by the sick person or a death that was not reasonably expected.

In short, there is nothing in Bill C-7 that will cause a substantial increase in requests for medical assistance in dying.

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I appreciate the opportunity to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying, which was introduced earlier this week and dramatically expands the existing euthanasia regime in Canada.

This bill was introduced in response to a ruling made September 11, 2019, where the Superior Court of Québec found, in Truchon versus the Attorney General of Canada, that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life.

I believe it is completely unacceptable that the government did not appeal the Truchon decision to the Supreme Court. Truchon struck down vital protections for vulnerable Canadians that the Liberal government put in place less than five years ago. Appealing this decision would have allowed us to get certainty on the framework within which Parliament can legislate.

The summary of the bill states that it amends the Criminal Code to:

among other things,

(a) repeal the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying...

It excludes mental health as an eligible reason to receive assisted suicide. It creates two sets of safeguards that must be respected before medical assistance in dying may be provided, which differ in application depending on whether death is reasonably foreseeable. It also creates an advance directive wherein a medical practitioner can proceed with assisted suicide without consent immediately before administering it, assuming all other criteria are met and the patient enters into an arrangement in writing with a medical practitioner or a nurse practitioner to cause death on a specified day.

While these changes are significant, it is the other things where I will focus most of my attention. In responding to Bill C-14 in the last Parliament and now to this bill, it has always been our priority, on this side of the House, to ensure that legislation permitting euthanasia and assisted suicide includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and allied health professionals.

Of all the proposed changes, I am most concerned about the removal of the 10-day waiting period. This was not a change mandated by Truchon. Rather, it is a deliberate choice by the Liberal government to strike down one of the most important safeguards for vulnerable people facing uncertain medical prognoses.

Nearly every one of us can think of someone in their lives, perhaps a friend, a grandparent or even a spouse, who has received a serious diagnosis. The emotional impact of hearing that news can be overwhelming for both the patients and their families. It can cause depression, anxiety and a great fear of the unknown.

I am sure many of us can also think of people we know who have received terminal diagnoses and went on to beat their illness and live for years afterwards. However, with the safeguard of a 10-day waiting period gone, such stories may be fewer and farther between.

Without having to take the time to come to terms with their situation, to speak to their families and to learn about treatment options from their doctors, many people will make emotional decisions based on fear.

Another amendment removes the need for two independent witnesses and allows health care workers to act as witnesses. People may not even hear another voice offering a different solution.

By making these changes, we diminish the extremely important role legislators play in contemplating all of the unintended outcomes and consequences and then protecting against them. We know very well that the current euthanasia regime has serious problems, that it has been abused and that it has been used as a tool of desperation after the failures of government.

Sean Tagert suffered from an advanced case of ALS that left him completely paralyzed, unable to speak and reliant on a ventilator. Despite these challenges, Tagert fought to stay alive so he could watch his son, whom he spoke of in lengthy Facebook posts, grow up.

Sean required 24-hour in-home medical assistance to stay alive. Initially the health care system provided him only 15 hours, leaving Sean to somehow pay hundreds of dollars each day. Eventually, even that was too much for the health authority. Health care authorities told Sean that he would no longer receive funding for home care, leaving as his only option institutional care at a facility hours away, separated from family and removed from the son he called his reason for living.

Sean appealed, but to no avail. He was going to lose his home care. Mr. Tagert fought long and hard for the rights of persons with disabilities and their families but in the end, he was driven by his desperate circumstances to believe that assisted suicide was his only option. He was “worn out”, in his own words. On August 6, 2019, he ended his life.

I am going to read from the statement his family posted at that time:

We would ask, on Sean's behalf, that the government recognize the serious problems in its treatment of ALS patients and their families, and find real solutions for those already suffering unimaginably.

“Real solutions” does not mean removing the safeguards for those who are the most vulnerable. It means providing true alternatives, be that palliative care, in-home care or the unique care needed.

It is not enough to simply put in legislation as we find here in proposed paragraph 241.2(3.1)(g), under Safeguards:

...[to] ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or...care.

If we have no intention of ensuring that those services are being funded or are even available, we have failed.

I note that the current federal government broke a key election commitment to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making. That point has been made over and over during this debate.

People should never be put in a position where they believe death is the only solution available to them. We are, and we must be, better than that. We must protect every human life with a jealousy born of the knowledge that each person is unique, and has an innate dignity that nothing, not time, not illness nor disability, can ever take away.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, it is an honour to speak today to Bill C-7 regarding medical assistance in dying. This is the second time, the first being in the last Parliament, that I have had the opportunity to take part in the debate on this absolutely essential legislation on such a difficult subject.

This bill represents a major improvement and reflects some of the amendments that I made but that failed in the House, in the 42nd Parliament. Some of those amendments, in fact, were picked up and approved by the Senate.

I want to stop and reflect on the trajectory of this issue in Canada.

As identified when I rose in my place, I am a member of Parliament for Saanich—Gulf Islands and I believe that Saanich—Gulf Islands may have more constituents concerned with and calling for medical assistance in dying than perhaps any other riding in Canada. There are two active death-with-dignity groups within my community, one on Salt Spring Island and one on the Saanich Peninsula, and I think it is for a very simple reason.

Feelings run high, and honestly, my constituents persuaded me in 2011 and 2012 that I had to stand up for ensuring that there was access to medical assistance in dying and stand up for removing the Criminal Code punishments for people who, motivated by compassion and basic human dignity, assisted someone who was dealing with unbearable suffering in their last days and weeks.

The reason that my community is so very implicated in this issue is that Sue Rodriguez was a resident of North Saanich. She was unable to take her own life due to the effects of ALS, but she was able to find a doctor, who remains anonymous to this day, who assisted her in ending her own life.

It is clear that many people in my riding support the measures in Bill C-7, as they did support Bill C-14 in the previous Parliament.

This is about helping to alleviate suffering through medical assistance in dying. This difficult and very serious situation is unfair to anyone.

Sue Rodriguez went to court, so it is also a trajectory of court cases. The Supreme Court of Canada ruled in 1993 against Sue Rodriguez. She was suffering from ALS. ALS runs as a thread through what I want to talk about today. Sue was losing ability and had lost ability to speak, to swallow and to walk. We know the trajectory of ALS. She asked the court to change the law and she was unsuccessful. That was in 1993. By the way, it was a very close decision. It was five to four, a very close decision. She died a year later, on February 12, 1994.

Then we take it to 22 years later. That is how slowly the laws evolve. It takes a while. The Supreme Court of Canada and the laws of Canada evolve to meet the changing circumstances. I think part of the reason is that we also realize now, unlike 20, 30, 40, 50 years ago, that we can prolong lives and sufferings through miracle advancements in medical science, but before we passed this law in the 42nd Parliament, we were denying people death with dignity and the ability to control their own decision-making about the timing of their own death.

Along came the Carter decision, finally, in 2015. Twenty-two years after the Supreme Court of Canada decision in Rodriguez, we had the decision in Carter. I felt very strongly when we debated the bill for medical assistance in dying in this place in the last Parliament, the 42nd Parliament, that our legislative efforts fell far short of what the Supreme Court of Canada ruled in Carter.

I felt quite sure, and said many times in this place, that the legislation we were passing, while an improvement, would not stand up to legal scrutiny and would be ruled unconstitutional by the courts. Now we have the decision that came out last September in the Truchon case, and again a court has given us a deadline to come up with an improvement. It is being called Audrey's amendment. Certainly a lot of people have identified with that situation, and their hearts have been broken by knowing that medical assistance in dying was out of the reach of people who were suffering gravely but feared they would not be able to form the required consent on the day of the procedure.

I think the bill before us is a substantial improvement, and it really reflects on how courts grapple with this issue and how society grapples with it.

I have to say that in the 42nd Parliament, I found the debate remarkably respectful. Across all parties, we recognized that these are serious matters of life and death, not to be trifled with and not to be turned into partisan debate. The reality is that in this legislation we do make amends for some mistakes in the previous bill.

I always find it rather odd that we have to find that a person's natural death is “reasonably foreseeable”. I do not think any of us in this place fancy ourselves immortal. All of our deaths are entirely foreseeable; we just do not know exactly the time and place in which they will occur.

Doctors of those who are suffering from a terminal illness are not even able to say the reasonably foreseeable date. What does it mean to be reasonably foreseeable? We put people in a stricture where even if they knew they had a terminal illness, such as ALS, they could not necessarily get aid from this legislation and they could not necessarily give advance consent to a doctor to indicate that they did not want to go through what they knew lay ahead of them.

One of my best friends emailed earlier today to ask me to stand up and fight this bill, because she is dying with ALS and she did not think the bill would cover her. I spoke to the Minister of Justice to confirm that I was reading the bill correctly and that, yes, they were thinking specifically of people with ALS.

Our friend who used to sit in that chair, Mauril Bélanger, was lost to us so quickly through ALS. My friend, who is losing the ability of speech, is in a chair and has tubes in her stomach that cause enormous pain. She knows that her lungs will give out, so she is emailing me while we are having this debate. I was really relieved to talk to the Minister of Justice and realize that I am reading the bill correctly, that my friend can get the help that is needed to be assessed and be able to say that she wants consent in advance.

However, I do think that there are some areas for amendments that should be made here, and I wish we had more time. I hope the court will give us the additional four months, but we do not know that.

Some of the bogeymen that have been raised here today I think are considered in the bill. We do have the requisite safeguards to keep vulnerable people safe. No one can give permission for medical assistance in dying other than the patients themselves. They still have to meet very tight criteria. They have to have a sworn witness. They have to have a doctor. The bill also provides that on the day of the procedure, if a person indicates that they have changed their mind, they are completely allowed and of course have the right to indicate that they have changed their mind through all sorts of gestures and words, but not through any involuntary gestures. I think the bill is drafted as well as it can be, but we will continue to consider it in the amendments at clause-by-clause consideration.

The bill does continue to ensure that the death is reasonably foreseeable, and there may be some complications there in the language. I note concerns from Dr. Jocelyn Downie at Dalhousie University, who is one of Canada's leading experts in this field, and I want to hear her evidence. I hope that she will be a witness, and I am sure she will be, as well as Dr. Stefanie Green, the president of the Canadian Association of MAID Assessors and Providers. We want to make sure we get the language right.

I will close by thanking the Minister of Justice and the government for following through and hearing the cries of Audrey, from Halifax, that her death be not in vain.

[Rachael Thomas, Conservative, Lethbridge, AB]

Madam Speaker, during this debate time, we have an opportunity as legislators to ensure that we carefully and thoughtfully examine Bill C-7 with the best interests of Canadians in mind.

On September 11, 2019, the Superior Court of Québec found that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. Although the current bill before the House, Bill C-7, responds to the court's ruling, it goes far beyond the scope of Quebec's decision and it weakens the important safeguards that have been put in place under Bill C-14.

Since the Liberals put this legislation forward, I have heard from hundreds of my constituents in a matter of days. They have shared with me that they are very concerned about the bill.

I will use my time today to share a number of the concerns they have raised and to issue a thoughtful word of caution to this place.

First, there is a parliamentary review of the original legislation scheduled for June. The question has to be asked. Why are we rushing to expand the scope of the current legislation?

We are literally discussing life and death issues. Death, something so final, deserves just a little of our time, our attention and due diligence.

The government's original legislation went through a very lengthy consultation process. This time, however, the consultation only lasted a couple of weeks. That is not the sole concern I have. In addition to that, when I look at this survey, the questions that were asked were quite vague and the multiple choice answers that were provided were drafted in such a way that the party in power could interpret those answers to the secure findings it desired. It was unclear and therefore unhelpful, if we really are going to respect the voices of Canadians.

However, the fact that this survey was so unhelpful goes to show that the current government was not interested in hearing from Canadians. The current government was interested in pushing through its agenda and therefore being able to twist and manipulate the survey data to its end, which is absolutely wrong.

It is wrong, because it goes against the very essence of this place, which is 338 common people representing common people. This place exists for us to deliberate the issues that matter most in our country and to speak up on behalf of Canadians. Unfortunately, what we have before us is a bill that represents the Liberal agenda rather than the voices of the Canadian people. This is wrong.

With legislation of this magnitude, I would urge the members of the House to slow the process down, to consult extensively and for us to come back to the table.

I cannot think of another responsibility we carry as legislators that is more crucial, more obligatory than our duty to protect the most vulnerable in Canadian society. Therefore, we have to take every effort to alleviate any possibility for abuse or misuse based on what is in this bill or based on what is left out of the legislation.

My Conservative colleagues have raised many concerns and have given multiple examples where extreme liberties have been taken with physician-assisted suicide where there are looser restrictions in place. I do not wish to rehash all those examples here today, but I certainly will draw the House's attention to a few.

Sadly, members across the floor have disregarded many of those examples provided by my Conservative colleagues. They have suggested that the differing jurisdictions and rules should deem these cases irrelevant in this place.

We have the opportunity and even the duty to learn from other countries and the way they have legislated, to learn from cases within our own country and to make changes that are necessary to properly protect Canadians.

It is undeniable that as one's medical condition progresses, the individual inevitably become more vulnerable. It is our responsibility to stand up for the vulnerable.

Individuals could lose their ability to speak, to move autonomously or they could lack the coherent and cognitive ability to be able to interact correctly. When an individual reaches this state, this is precisely when the safeguards around MAID, medical assistance in dying, should be strong enough to keep them safe rather than weak enough to make them vulnerable.

The proposed change in the bill would allow for advance directive, which takes away the need for the patient to consent immediately before having medical assistance in dying administered. This proposed change is alarming and dangerous as well to the Canadian public.

When we are faced with difficult physical ailments, they often fluctuate in intensity and as they do, our decision-making ability shifts. Think for example about people who are suffering from terminal cancer. They have been advised by medical professionals that their quality of life is likely to deteriorate to a certain degree by a specific date. Let us say that does not happen. Those cancer patients who want to avoid unnecessary pain have already given the date on which their lives will be terminated.

Changes take place. What if the diagnosis the doctor gave was not right? What if those patients have actually fared much better? Health care professionals could in fact euthanize these individuals at any point without needing to obtain consent immediately before death is administered.

This should concern all of us because of the vulnerability that is in place here. There should be a requirement for contemporaneous consent. We cannot allow one's former self to dictate the will of his or her present self. Minds change, circumstances change, so final consent is an absolute necessity.

This example has been raised in the House at least once before, but it is worth raising again because it is close to home.

Taylor Hyatt is a staffer on the Hill. I had the opportunity to interact with her personally. She has a linguistics degree from Carleton University. She lives on her own and she loves her life. Taylor has cerebral palsy and is restricted to a wheelchair. She lives an incredible life and contributes to Canadian society in a multitude of ways.

Two years ago Taylor went to the hospital because she was feeling quite ill. The doctors did some tests and they said that whatever it was it really was affecting her breathing, and if it came to it, should they administer oxygen.

Taylor was quite surprised at the question. Of course she would want oxygen, that seems like a very basic thing. It is not like it was life support or something that people often take, those decisions of that magnitude, quite seriously. It was the simple administration of oxygen. A few seconds later, the doctor asked "Are you sure?", and he said it in such a way that he was actually applying pressure on her to reconsider her decision, as if to say that her life lacked the value that she felt it had.

That is atrocious. If we are sending that message to the most vulnerable in our society, then what have we become?

I would like to also address one other thing, and that is the need for palliative care. If we are going to talk about administering death to Canadians, then why are we not having a conversation around long-term care? If we are going to talk about the dignity of a human life, then what about those who want to live a dignified life right up until their last breath?

Why is the government not moving forward with the plan it promised to put in place with regard to palliative care? Why is it not spending the money that needs to be spent on preserving the dignity of those who wish to choose this type of death? These are essential questions with which the House must wrestle.

I would caution those within this place to take a step back, because we want our country to be one that supports all people.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Mr. Speaker, I am pleased to rise today in support of Bill C-7, which proposes amendments to the Criminal Code's medical assistance in dying regime, in response to the Superior Court of Québec's Truchon decision. I will provide the context for the change.

As we know, in September 2019, the Superior Court of Québec struck down the federal and Quebec criteria that limit the access to MAID based on circumstances where death is reasonably foreseeable. The court, whose ruling only applies in Quebec, suspended its declaration of invalidity for six months, until March 11, 2020. On February 17, the Attorney General of Canada filed a motion to request a four-month extension to give Parliament the time needed to implement a response and ensure that the law across the country is consistent as it relates to the federal MAID regime.

I will provide a brief overview of the amendments to the Criminal Code that are being proposed under Bill C-7.

First, on the eligibility criteria, the bill would repeal the reasonably foreseeable natural death criteria and exclude persons whose sole underlying medical condition is a mental illness. Second, with regard to safeguards, the bill would create two sets of safeguards, depending on whether a person's death is reasonably foreseeable, while easing some existing safeguards and adding new ones for persons whose death is not reasonably foreseeable. Finally, the bill proposes to allow for a waiver of final consent on the day of the procedure in specific circumstances.

How did these changes materialize? The development of this legislation was informed by the Truchon decision; available Canadian and international reports, such as the December 2018 report of the Council of Canadian Academies; the experience of existing international regimes; and our government's recent consultation on MAID, held in January and early February.

The Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, along with their parliamentary secretaries, hosted several federal MAID round tables across the country. These events were attended by experts and stakeholders, including doctors, nurse practitioners, representatives from health regulatory bodies, legal experts, representatives of the disability community, indigenous representatives and other key stakeholders. They shared their experience and insight into MAID and its implementation in Canada over the last four years.

In parallel to these efforts, our government heard from over 300,000 Canadians who participated in the online public survey on MAID between January 23 and 27, 2020. There was an unprecedented number of respondents, reflecting the significance of this issue for Canadians. This kind of input is invaluable to government and, I am certain, was seriously considered by the ministers in the development of the bill.

I would like to provide a personal perspective on the issue of MAID in its previous iteration.

In 2015, when the Liberal government came to power, it was tasked by the Supreme Court to amend MAID. A special joint committee was established, involving both Houses and all parties. The special joint committee conducted an enormous amount of consultation and came up with a proposal. The then minister of justice and minister of health were presented with this proposal. Through intense discussions and consultations, the proposal was amended.

In my riding of Don Valley East, I did a consultation in the sanctuary of the Donway Covenant United Church. Various constituents, as well as other members from across Toronto, participated in the town hall. Members of CARP, the Canadian Association of Retired Persons, were also on the panel. It was an emotional meeting. I clearly remember one of my constituents, who was non-verbal and had to use her communication board, telling me that she wanted advance directives while she was lucid but could not predict whether she would be lucid in the foreseeable future.

In 2019, I had to do another presentation at a church in another riding. Here, overwhelmingly the audience was against the phrase “foreseeable future” and also wanted advance directives.

I am glad to see that some of the changes requested through consultations have now been incorporated. I look forward to the five-year review that is scheduled for June 2020 to see the discussions around advance directives.

I will now go to the bill itself and some of the changes it proposes to the eligibility criteria.

With regard to the proposed Criminal Code amendments in relation to eligibility, the bill proposes to make two changes to the current set of eligibility criteria for MAID. First, it would repeal the reasonable foreseeability of natural death criteria from the list of eligibility criteria in response to the Truchon ruling. That is good news for some of my constituents in Don Valley East. The legal effect of this amendment would be that those whose natural death is reasonably foreseeable and those whose natural death is not reasonably foreseeable would be eligible for MAID if they met all other eligible criteria.

Second, the bill proposes to exclude people whose sole underlying medical condition is mental illness. Many practitioners, stakeholders and experts have identified increased complexities regarding individuals seeking MAID whose sole underlying condition is mental illness. I suggest that this could be an item for Parliament to look at it in its upcoming mandatory five-year review of the MAID regime.

The Council of Canadian Academies' experts group issued a report in 2018 on the same issue and could not come to a consensus on this question. The Government of Quebec has also announced that access to MAID for cases where mental illness is the sole underlying condition would be suspended and that a broad consultation process would be conducted on this issue.

Regarding safeguards, the public needs to know some of the safeguards that will protect the vulnerable. With respect to the applicable safeguards proposed, the proposed Criminal Code amendment would create two different sets of safeguards depending on whether a person's natural death is expected in the near term or not. The first set of safeguards would continue to be tailored to persons who have a reasonably foreseeable death where risks are reduced. The second set of safeguards would be tailored to persons whose death is not reasonably foreseeable and would address the elevated risks associated with the diverse sources of suffering and vulnerability that could lead a person who is not nearing death to seek access to MAID, such as loneliness, isolation, lack of adequate supports and hopelessness.

Bill C-7 proposes to use the reasonable foreseeability of natural death standard to determine which set of safeguards applies to a particular case. This standard would also determine whether a person who is assessed and approved for MAID but who risks dying before the day of the procedure can give consent in advance. I will be discussing that proposal shortly.

How will these safeguards be applied? Specifically, it would require that a MAID request be witnessed by one independent witness instead of two, and it would allow individuals who are paid to provide either health or personal care to act as an independent witness.

On the advance consent or directives, the bill proposes amendments that would allow people who have a reasonably foreseeable natural death, and who have been assessed and approved for MAID, to retain their ability to receive MAID if they lose the capacity to consent.

The bill represents a significant paradigm shift in Canada's legal landscape with regard to medical assistance in dying. I call on members to support this important legislation and send it to committee for further review.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, as parliamentarians it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles that were outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles that, although largely restated in Bill C-7, are being watered down and undermined by this legislation.

As recently as the early 1990s, in the landmark Rodriguez case, the court ruled that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has the difficult task of balancing the autonomy of Canadians with our responsibility to create safeguards for vulnerable Canadians. It is one of our most sacred responsibilities to protect the lives of our citizens. We need to get laws on assisted dying right.

The adoption of medical assistance in dying after the 2015 election is an event I am very familiar with. I had the honour of serving under the member for St. Albert—Edmonton as he took the lead as the Conservative vice-chair of the Special Joint Committee on Physician-Assisted Dying. During this time, I was involved in all aspects of the committee that was making recommendations on a new law. I heard from all the witnesses, and I listened to all deliberations regarding what direction our country should take.

That committee recommended a radical departure with very few safeguards. These recommendations did not reflect the testimony of experts, but instead the political agenda of special interests.

The Conservative minority report provided at the joint committee was entrenched firmly in the principles of the Supreme Court's decision in Carter, and included recommendations that were laid out by key witnesses, such as the former president of the Canadian Psychiatric Association, Dr. Karandeep Sonu Gaind. It outlined key principles for us on the issue of physician-assisted dying.

These included not accepting the provision that assistance in dying be provided to those under the age of 18, in line with the Carter decision, which stated that only competent adults should be allowed access to assisted dying. We also did not accept the extension of medical assistance in dying for those suffering exclusively from mental illnesses. We did not believe that any mental illness is irremediable, as the Canadian Psychiatric Association stated.

We also did not believe in the validity of advance directives to allow Canadians to consent to an assisted death far in advance of its administration. This change would stand opposed to the express will of the Supreme Court of Canada, which ruled that consent must be contemporaneous with the time of death.

We also recognized the lessons of the Quebec experience, as the first jurisdiction in this country to legalize euthanasia. In its regime, medical assistance in dying could only be rendered on adults with a severe, incurable physical illness, characterized by an advanced state of irreversible decline.

I believe many Canadians can sympathize with this limited exception for assistance in dying; however, even these safeguards have proved to be short-lived. Barely five years later, the courts and the government have decided that these safeguards are far too restrictive.

How did we get here today? Barely had the ink dried on Bill C-14 before proponents of expanded assisted dying launched their campaign to eliminate necessary safeguards.

As a Conservative who strongly believes in the sanctity of human life, Bill C-14 was a difficult pill to swallow. However, it was one that I believed upheld many of the values that I hold and the values that many of my constituents hold.

The previous legislation recognized that we must tread carefully with this new reality of assisted dying. It introduced safeguards that limited mature minors, those with exclusively mental illnesses and those whose deaths were not reasonably foreseeable.

I believe this is where the majority of Canadians are, and I believe the government largely got the balance right under Bill C-14. Unfortunately, there are a radical, vocal few who want to undermine even these protections and push this country headlong into a permissive regime for assisted dying, a regime that, as we know from international experience, has resulted in the deaths of vulnerable people.

If we continue to go down this road and liberalize all safeguards, we will continue to see mistakes and deliberate actions that end the lives of vulnerable people. This new legislation outlined in Bill C-7, although not taking these large, radical steps that I outlined, is opening the door to a wider radical departure from principles like the protection of the vulnerable and the sanctity of human life.

I am particularly concerned about the inclusion of the term and policy of advance consent.

The Supreme Court of Canada was very clear, crystal clear, that an assisted death should only be administered with the consent of a person at the time of death. We know that there are some cases where people fear losing their capacity to end their lives. However, we cannot allow the precedent of advance consent to gain legitimacy in our system. Advance consent in this legislation I believe is a Trojan horse designed to build the legal case to accept the adoption of advance directives.

Advance directives are a concept by which people can direct the actions of medical professionals after they have ceased to have the capacity to consent to an assisted death. Many Canadians are familiar with DNRs: do-not-resuscitate orders. DNRs are a completely ethical and morally acceptable practice, whereby a patient can designate that no action should be taken to attempt resuscitation. By respecting the will of the patient and not acting, medical professionals are allowing the patient to die a natural death. Medical professionals can also hasten the natural death of their patient through pain remediation. I believe this is also an acceptable practice.

I support do-not-resuscitate orders, and I think many Canadians are being deliberately misled into believing that an advance directive is the moral and ethical equivalent of a DNR. It is not. An advance directive does not ask medical professionals to withhold action allowing a natural death. It requires medical professionals to take direct action to immediately end the life of the patient.

This is a leap in practice that goes far beyond what I believe is ethical. It undermines one of the greatest medical principles: first, do no harm. I can imagine, in a not-so-distant future, someone with dementia or Alzheimer's who had previously written an advance directive, believing that life would be not worth living with this disease. Imagine in the future that we had the medical expertise and the breakthrough pharmaceuticals that could make life better for those suffering. How can someone consent to have life end without contemporaneous consent at the time of death, when they cannot know what their quality of life will be?

It introduces a high level of subjectivity to the question about what kind of life is a life worth living. This is a dangerous question that will lead us down a lethal road, a road that I do not think anyone wants to go down today. I believe it is unethical and dangerous to allow someone's life to be ended by an advance directive or consent, even with the meagre protections offered in Bill C-7, which includes a provision that no resistance be shown. There is still a threat of abuse. If people are unable to understand and consent to death, how are they supposed to know to resist when someone comes to administer their death?

Parliament is being rushed into liberalizing a practice that is not even half a decade old. Its members lack the experience, the data and the moral understanding to press forward with such a life-and-death issue. I am disappointed that the government abdicated its responsibility to stand up for vulnerable people when it chose not even to appeal the Quebec court's decision to the Supreme Court of Canada. What better court to clarify what safeguards are acceptable than the very court that originally dealt with these significant matters?

Instead, the government has given Parliament little time to contemplate such an important issue. Canadians are still catching up to the reality of assisted dying being legal in this country, and now we are foolishly pressing forward before we can fully understand the impacts of this legalization.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I rise today to address Bill C-7, an act to amend the Criminal Code, medical assistance in dying.

Assisted dying is the leading moral and ethical issue of our time. Previously respected traditions supporting the sanctity of all human life until natural death have been tossed aside, most recently with the Supreme Court's decision in the landmark Carter case.

As parliamentarians, it is incumbent upon us to draft responsible legislation that protects the sanctity of life, protects those contemplating suicide and protects vulnerable peoples. These are principles outlined in the preamble to Bill C-14, the landmark legislation that governs assisted dying in this country. These are principles, although restated largely in Bill C-7, that are being watered down and undermined by this legislation.

As recently as the early 1990s, the Supreme Court ruled in the Rodriguez case that there was no constitutional right to assisted dying in this country. The Carter decision overruled that previous decision, and now Parliament has been tasked to take on the difficult task of balancing the autonomy of Canadians with protecting vulnerable people.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Alleged Premature Disclosure of Private Member's Bill

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, the hon. member mentioned that he did not want to waste the time of the House, yet he went on, when we are debating medical assistance in dying, on a question of privilege about a private member's bill. I would point him back to earlier this week when the entire contents of Bill C-7, medical assistance in dying, was in a CP story the morning before the bill was introduced. This is just for his reference.

Criminal Code

[Majid Jowhari, Liberal, Richmond Hill, ON]

Mr. Speaker, it gives me great pleasure to once again rise in this House and speak to Bill C-7, an act to amend the Criminal Code (medical assistance in dying). This bill proposes amendments to the Criminal Code provisions on medical assistance in dying, or MAID, in response to the Superior Court of Québec Truchon decision, which struck down the eligibility criterion that natural death be reasonably foreseeable.

I would like to highlight five major components that stood out for me.

First, it repeals the condition that a person's natural death be reasonably foreseeable, with the exception of patients whose sole underlying condition is mental health issues.

Second, it introduces new safeguards in addition to existing ones for patients whose natural death is not reasonably foreseeable.

Third, it permits the waiver of the requirement for final consent, allowing patients to provide consent to health care practitioners in advance, in the event that their death is naturally foreseeable and they are at risk of losing capacity to consent.

Fourth, it permits the waiver of the requirement for final consent if a patient chooses MAID by self-administration, in case complications arise following self-administration, such as a loss of capacity.

Fifth, it modifies the MAID monitoring regime to require that health care providers and pharmacy technicians provide regulated information when assessing a patient's eligibility or when dispensing a substance for MAID.

Over the last two days, many of my colleagues from both sides of this House intervened on a fair number of details. It gives me great pleasure to see that there is broad agreement that this legislation, with these amendments, gets voted in and move to the committee for further study.

I rose in this House during the 42nd Parliament back in 2016, and shared my experience, which dealt with the tragic loss of my father as a result of stage 4 cancer back in 2014. Such assistance was not available to us and we saw the loss of dignity. We saw the loss of the person I called “my hero” losing the capacity to be able to function and lead our family, as well as the fact that his desire would have been met, had we had this type of assistance available.

Also, as the chair of the all-party mental health caucus, I have been advocating, and our caucus has been advocating, for the consideration of mental health and the exclusion of that. I am pleased to see that that remains.

As I was listening attentively to the interventions over the last two days, at times there were questions raised about why it took so long. Considering that, and considering that we are almost halfway through this debate, I decided to focus my intervention mainly on the journey that our government has gone through over the last four years. The key concepts within that journey are the challenges that we are faced with; the stakeholders that we engaged with; the consultations during the studies; and the implementation, successes and challenges we have had.

Having said that, since the introduction of the legislation for medical assistance in dying in 2016, we have witnessed a steady increase in the number of Canadians and health care providers who have adopted this new regime. We have seen a relatively smooth integration of MAID assessments and delivery in end-of-life care service available across the country.

The enactment of this historic legislation was just the beginning of our efforts. Our government has since been very active in supporting the implementation of MAID across Canada. The 2016 legislation included clear directives for action, including the need for government to initiate independent reviews on three complex issues not addressed in the bill back in 2016. Some of my colleagues before me touched on those complex issues.

Rather than proceed too hastily, Parliament felt that it required more study and a review of available evidence. The government tasked the Council of Canadian Academies with undertaking these studies and that is where the journey started.

The resulting report tabled in Parliament in 2018 reflected an extensive review of academic and policy research, stakeholder submissions and international expertise in all three areas. It documented a range of perspectives from health care professionals, academic disciplines, advocacy groups and indigenous leaders; hence, the stakeholders that we have engaged with. We expect dialogue on these issues to continue during the parliamentary review and, as I have indicated, I hope that everyone in the House votes for this so that we can move it to committee and continue this dialogue.

Taking into account our federal system and division of responsibility for health care and criminal law, the federal government developed the monitoring and reporting regime to collect valuable information about requests for and the provision of MAID. In all other jurisdictions permitting assisted dying, there is an oversight and monitoring mechanism in place. The roles and responsibilities of these monitoring regimes vary.

In the wake of this monumental shift toward legalized assisted dying, Canadians wanted to know what kind of uptake there would be. Some were keen to know how accessible MAID would be across this vast country. Others want to know how safeguards would be applied and if there were protections in place for the vulnerable. Our government worked quickly with the provinces and territories to establish an interim reporting system, collecting and reporting on the best data available.

I want to acknowledge our provincial and territorial partners that had the challenging task of arranging safe access to MAID services from scratch, in a short period of time and in collaboration with multiple partners, such as health care providers, professional associations and health care delivery institutions. This tremendous task involved setting standards of practice for physicians, nurse practitioners and pharmacists to support the consistent and safe delivery of MAID within a legally sound framework. It also helped minimize the disparity to access in rural and urban areas.

Our government produced four interim reports using data voluntarily transferred by providers and various jurisdictions from 2016 until the creation of the permanent regime in late 2018. These reports covered a six-month period and provided information on the number of MAID deaths, patient demographic information, underlying medical conditions and predicted MAID requests.

In reviewing these reports, we know that the awareness of MAID as a legal option is growing. There appears to be a growing comfort among health care providers. In the interim period, our government worked to establish a permanent national monitoring and reporting system as considered in Bill C-14.

Through stakeholder consultation and collaboration with provinces and territories, the government enacted federal monitoring regulations in late 2018. These regulations set out the reporting requirements for all physicians, nurse practitioners and pharmacists who participate in MAID. We were mindful of balancing the need for information while limiting the reporting burden on health care providers and avoiding duplication of effort. This system has been operating for just over a year. Late this spring, our government plans to release the first annual report using data from this new monitoring system.

Budget 2017 announced $11 billion over 10 years to support home and community care services, including palliative care, mental health and addiction services; $6 billion was specifically allocated to those services I talked about. In 2019, our government worked with all the provinces and territories to develop the framework for palliative care in Canada, which I consider a cornerstone of this bill.

Over the last three and half years that MAID has been available, our government has worked to support a smooth integration into the health care system based on the foundation I have just laid out. On the evidence that we have gathered, we have put together a bill that represents the Truchon decision and addresses other issues where there is clear consensus and a reasonable path forward. It is my hope that, after due consideration and debate, we move this bill to committee.

I will close by saying that I support this bill and I thank all members for intervening on this topic.